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        <p>2.切端定深和磨除<br>a.工具型号：RS874-314-012-2ml(16万/分/有水)<br>车针黑标宽度0.5mm，车针工作端宽度2.0mm。<br>b.放置位置：切端1.5mm。留下0.5mm空间精修。<br>c.方向：与切端内斜面垂直（切端均匀降低确保前导瓷的厚度）<br>d.术式：手、腕、前臂固定（短力矩近支点原则）<br>e.车针唇舌运行轨迹：与切端内斜面垂直（可用牙周探针比对）<br>f.定深沟数量及校对：3条均匀分布近远中使用牙周探针校对<br>g.磨除要点：车针与切端内斜面平行伸缩式磨除（测量预备后的切端厚度）<br>h.切端定深磨除标准：切端及内斜面均匀降低1.5-1.8mm(反复有损耗）<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/01.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/02.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/03.png"><br>3.排龈（设计龈上边缘不需要）<br>a.材料和工具：排龈线和排龈器和单刻度牙周探针<br>b.测量龈沟深度：决定选线的直径<br>c.观察牙周基础：排龈建立在健康的牙周基础上<br>d.选线：第一根直径+第二根半径 &lt;  龈沟深度<br>e.第一根线排放时机：邻面分离和切端完成后<br>f.第一根线排目的：垂直退缩为主水平为辅确定肩台外缘线<br>g.第一根线位置标准：平齐龈缘内侧（平视不见俯视一圈）<br>h.第一根线头对接方式：端端对接不可重叠（重叠占龈沟深度和易被带出）<br>i.第二根线排放时机：彻底预备完成后准备取模前<br>j.第二根线排放目的：压第一根排龈线向下并同时推龈缘水平向外获得龈沟与肩台的空间。<br>k.第二根线排放标准：直径进入一半（直径最粗的地方）线头可重叠。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/04.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/05.png"><br>龈沟深度小于1.0mm，第一根线选000或00的排龈线<br>龈沟深度大于1.0mm，第一根线选00，第二根0.<br>龈沟深度大于1.5mm，建议先消除牙龈龈袋，再排龈。<br>干线，剪线不要留毛刺，比一下周长。<br>先将一侧邻面进入，线头埋在舌邻转角1mm处（附着龈致密有固定作用）<br>邻面先牵拉进入平齐牙龈内侧缘固定舌侧线头，先有空间再入线的理念——勿强塞。<br>4.肩台外缘线确定<br>a.工具型号：RS801-314-016-ml (16万/分/有水)，就是球钻<br>b.放置位置：平齐龈缘线（排龈前的标记线）<br>c.方向：与唇侧中1/3平面约呈15度<br>d.术式：手、腕、前臂固定（短力矩近支点原则）<br>e.车针近远中运行轨迹：与龈缘线平行一致（预防局部边缘线外露）<br>f.进针深度：球形直径的1/3-1/2（球钻杆的占位）<br>g.向根方延展深度：根据测量龈沟的深度和排龈退缩的距离来定位置（确定外缘线）<br>h.施力的要点：向根方向外侧（复习肩台调整）推龈器保护牙龈（向心法制备）<br>i.完成标准：肩台外缘线确定，牙龈不损伤。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0152-2019rdh/025/06.png"><br>向心式预备，更好保护龈乳头。(从邻面向中心，近远中都如此）<br>5.唇面定深<br>a.工具型号：RS39-314-010-0.8-1.0ml(16万/分/有水)<br>b.放置位置：垂直于颈、中、切平面定深<br>c.深度：颈1/3 0.8mm 中1/3 1.0mm 切1/3 1.0mm<br>d.术式：手、腕、前臂固定（短力矩近支点原则）<br>e.位点分布：颈、中、切每个平面各3点<br>f.进针方式：提拉式进针（保证足够水冷）<br>g.定深后处理：干燥涂黑<br>h.完成标准：形成均匀分布的定深点<br>6.唇面磨除定深<br>a.工具型号：RS881-314-010/012-8ml (16万/分/有水) 黑标距车针头部4mm，黑标0.5mm，车针尾部距黑标3.5mm。目的，随时监测预备体高度。<br>b.颈部打磨车针放置：头部与内缘线接触方向与就位道一致<br>c.颈部打磨直径选择：1.0直径（大直径易伤牙龈）<br>d.术式：手、腕、前臂固定（短力矩近支点原则）<br>e.施力方向：向牙体向切端的运动趋势（防止飞边产生）<br>f.车针头部运行轨迹范围：与龈缘走形一致范围不转向邻面<br>g.切中打磨车针放置：与切1/3平行头部到达中1/3中部<br>h.切中打磨直径选择：1.2mm（快速切割不易形成凹痕）<br>i.切中打磨术式及范围：半切式术式和范围勿转向邻面<br>j.标准：唇侧三平面制备后为二平面磨除深度颈部0.8-1.0mm，切中1.0-1.2mm。导板检查。<br>7.邻面外缘线确定<br>a.工具型号:RS878-314-010-8ml(16万/分/有水）<br>b.放置位置：肩台外缘线利用车针头部一半为工作部分（分离后形成的肩台）<br>c.方向：就位道（长轴或垂直牙合面）<br>d.术式：手、腕、前臂固定（短力矩近支点原则）<br>e.施力方向：向根方及外侧（肩台深度调整原则注意防护）<br>f.车针唇舌运行轨迹：顺应龈缘起伏平行就位道（偏斜易过量切割）<br>g.外缘线深度：龈沟深度一半（建议参考排龈前的龈沟深度）<br>h.标准：深度合适外形与牙龈外形一致不损伤牙龈。</p>
<p>个人总结：前牙切端、肩台、唇面、邻面的预备。</p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的知乎文章地址： <a target="_blank" rel="noopener" href="https://www.zhihu.com/people/zhao-you-min/posts">https://www.zhihu.com/people/zhao-you-min/posts</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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